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PENNSYLVANIA CVS PHARMACY, L.L.C.
DSH390185 LEHIGH VALLEY HOSPITAL-HAZLETON
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Covered Entity Details
Entity Name
LEHIGH VALLEY HOSPITAL-HAZLETON
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH390185
Entity Address
700 EAST BROAD STREET
HAZLETON, PA 18201
Medicare Provider Number
390185
Participating Start Date
4/1/2019
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
PENNSYLVANIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01572
1185 NORTH CHURCH ST.
HAZLE TOWNSHIP, PA 18202
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/4/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Thomas Marchozzi, Executive Vice President & Chief Financial Officer
(484) 862-3943
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2021
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